Thapa N, Chongsuvivatwong V, Geater A F, Ulstein M, Bechtel G A
Birendra Hospital, Kathmandu, Nepal.
Soc Sci Med. 2000 Nov;51(10):1447-56. doi: 10.1016/s0277-9536(00)00045-9.
This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.
本文概述了在尼泊尔一个偏远地区开展的一项基于社区的回顾性研究，并描述了当地的分娩习俗及其对婴儿死亡率的影响。数据收集分两个阶段进行，1996年9月至10月的家庭调查以及一个定性研究阶段。收集的数据包括社会经济背景、生育史、分娩习俗和儿童生存情况。在3007名活产儿童中，660名（22%）在一岁前死亡。按照当地习俗，大约一半的孩子在牲畜棚分娩，另一半在家里分娩。即使在对社会经济地位和生物学变量进行调整之后，在牲畜棚出生的孩子死亡风险仍显著高于在家中出生的孩子。这种关联在新生儿期（比值比=2.8，95%可信区间1.9 - 4.1）比在新生儿后期（比值比=1.3，95%可信区间1.02 - 1.6）更强。分娩地点的准备不足，从而促使新生儿和母亲都受到感染。传统规范和在牲畜棚分娩的做法在朱姆拉社区很常见。在牲畜棚分娩的原因包括：（1）如果在家中分娩，家庭神灵会发怒；（2）产后便于打扫牲畜棚。
